Endoscopic and arthroscopic surgery are minimally invasive surgical procedures that are performed through small incisions or natural body openings. These procedures typically involve use of specialized devices and remote-control manipulation of instruments with indirect observation of the surgical field through an arthroscope, endoscope or similar device. Comparing to open surgery, endoscopic and arthroscopic surgery may result in shorter hospital stays, or allow outpatient treatment.
The Plantar fascia is a thick band of connective tissue running along the bottom (plantar) surface of the foot, connecting the heel bone to the toes. It helps support the overall shape of the foot, especially when standing. Irritation or scarring of the plantar fascia, known as plantar fasciitis, is one of the most common causes of heel pain or pain in the plantar surface of the foot.
Typical first line treatments for plantar fasciitis are non-surgical interventions. Such treatments include therapeutic exercises to stretch the plantar fascia, orthotic inserts such as arch supports, non-steroidal anti-inflammatory drugs (NSAIDs) and steroid injections. Failure of these remedies to relieve the condition may lead to a need for surgical plantar fascia release.
Conventional surgical techniques and equipment for plantar fascia release require a fairly large incision on the foot above the heel pad, where the thicker skin of the sole meets the thinner skin of the back of the heel, or an incision is made on the bottom of the foot. These techniques can require a longer period of recovery than endoscopic methods and have greater levels of post-operative pain due to the incision size and level of manipulation during the procedure. Following conventional open surgery techniques, a patient may need to wear a non-weight-bearing cast or brace for 2 to 3 weeks after surgery to allow tissues to heal.
Typically, endoscopic surgery has involved a number of steps and separate devices for performing plantar fascia division. Incisions are made on both sides of the heel and a path passing across the plantar fascia is opened between the two incisions using a blunt instrument so that a cannula can be inserted into the path. In order to smoothly insert the cannula, the central lumen of the cannula must be filled with a device, such as an obturator. The obturator is then removed and a viewing device, such as an endoscope or arthroscope, is inserted into the cannula from one side to view the plantar fascia. A knife is then advanced into the cannula from the other side and the knife and viewing device must them be moved together for viewing and dividing the plantar fascia. This requires the practitioner to move both hands in concert on opposite side of the foot. This technique allows the patient limited weight-bearing immediately after the procedure and less pain than the conventional open surgery, but still requires multiple incisions and the introduction of multiple surgical tools through those incisions.
Accordingly, the ability to perform endoscopic or arthroscopic surgeries in the lower extremities by making a single incision and using a single disposable device that contains the tools needed for a procedure would decrease the risk of infection, as well as postoperative pain and healing time versus present methods.
The present application fulfills a need in the art for a compact device for uniportal surgery in the lower extremities that eliminates the need for a separate device, such as an obturator, for filling the cannula during insertion and eliminates the need to remove the endoscope in order to insert a blade or blade assembly.